UT Southwestern patient among first in North Texas to receive permanent heart implant

1:13 April 20, 2010

Dr. Hughes Cox, 78, of Shreveport, La., is among the first patients in North Texas to receive a device that will assist his weakened heart for the rest of his life. The treatment, called “destination therapy,” is for patients in end-stage heart failure. They can now undergo surgery to implant a left-ventricular assist device (LVAD), which helps supply oxygen-rich blood through the body.

Dr. Mark Drazner

The pump rests inside the patient’s chest. A thin cable attached to the device exits the body and connects to a controller powered by a battery pack. UT Southwestern is a primary testing site for new technologies such as LVADs.

“Prior to the approval of LVADs for destination therapy, the prognosis for patients with advanced heart failure was not good,” said Dr. Mark Drazner, a nationally recognized heart-failure expert and medical director of the Heart Failure and Cardiac Transplantation Program at UT Southwestern. “Survival rates of less than 50 percent in one year could be expected.”

For Dr. Cox, Food and Drug Administration signoff of the LVAD for permanent therapy came at a critical time. He had a quintuple bypass in 2001 after suffering a heart attack. Dr. Cox’s heart continued to weaken and toward the end of 2009 his energy level decreased, said his wife, Judy Cox.

The Coxes knew their options were running out. Dr. Cox was simply too weak for a heart transplant; his medications were failing to keep his symptoms from worsening; and worst of all, he was losing independence to do the things he and his wife loved: traveling and spending time with their family.

“Cardiac transplantation is the gold-standard therapy for such patients, but its use is constrained by donor-organ availability,” said Dr. Drazner, associate professor of internal medicine. “Saying we were pleased that this approval came through for Dr. Cox and other patients is an understatement.”

On Jan. 20, the couple decided to go out to dinner to celebrate two occasions – their wedding anniversary and the FDA’s destination-therapy approval of the HeartMate II LVAD, manufactured by Thoratec.

“It was the best news we’d had in months,” Dr. Cox said.

Dr. Dan Meyer

Dr. Cox, retired chairman of philosophy at Centenary College of Louisiana, recognized destination therapy as his best hope for recovery and found out about the LVAD program at UT Southwestern from a family friend, who coincidentally had an LVAD.

“This new technology, approved by the FDA as an alternative to transplantation, gives patients a new option, when in the past they had none,” said Dr. Dan Meyer, professor of cardiovascular and thoracic surgery. “While this does involve a major surgical procedure, most patients are able to go home 10 to 14 days after surgery and engage in normal activity, including driving and traveling.”

Dr. Meyer said that, in the future, these pumps should last more than 10 years, truly becoming a viable alternative to transplantation for patients that do not want to manage the risks of the multiple immunosuppressive medications needed after heart transplantation.

Soon after the February surgery, Mrs. Cox said she saw an immediate change – her husband’s coloring improved. “Even as sick as he was, postoperative and in the intensive care unit, he looked so much better,” she said.

Dr. Drazner said Dr. Cox has responded well and has begun the process of rehabilitation and regaining his strength, which he lost during his prolonged battle with heart failure.

The couple will stay in Dallas for Dr. Cox’s therapy and until he is strong enough to return home. UT Southwestern doctors hope there are more patients for whom destination therapy is a good option for overcoming the symptoms of congestive heart failure.

“The doctors say I’m right on target in terms of recovery,” Dr. Cox said. “I’m grateful to have a good support system at home, and I’m determined to get better and better.”

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